Provider Demographics
NPI:1255218335
Name:OWOH, ANTHONY CHISOM (RPH)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:CHISOM
Last Name:OWOH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 S CLINTON AVE APT 12C
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8675
Mailing Address - Country:US
Mailing Address - Phone:631-324-0767
Mailing Address - Fax:
Practice Address - Street 1:825 CONNETQUOT AVE
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1423
Practice Address - Country:US
Practice Address - Phone:631-581-5496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist